When our team accepted the 2026 Pega Partner Award for Excellence in Healthcare and Life Sciences at PegaWorld in Las Vegas, the recognition carried a clear responsibility. It is not a signal to pause. It is a commitment to keep raising the bar.

Healthcare does not allow standing still. Health plan leaders, whether managing a regional plan or a national payer ecosystem, face the same pressures: shifting mandates, rising administrative costs, and technical debt that steadily erodes daily operations.

This recognition reflects 25 years of complex healthcare transformation and modernization work, as well as the business outcomes delivered along the way.

The "legacy trap" and the real reality on the ground

At PegaWorld 2026, our session, "Architecting the Agentic Terraform: Liquidating Legacy Debt for an AI-First Future," co-hosted with colleagues Greg Price and Wayne Marshall, addressed a persistent industry problem. Many healthcare organizations remain constrained by legacy systems they have wanted to replace for a decade, largely due to fear of disruption.

COBOL backends, VSAM data structures, and years of custom-coded rules make any change feel high-risk when operational data is live. The common response is to add new interfaces on top of old systems and hope the core holds for another quarter. This approach delays transformation rather than delivering it.

Progress requires treating technical debt as something to systematically dismantle through enterprise-grade engineering, not as a permanent constraint to manage around.

Why Virtusa: engineering depth built for healthcare

Many consultancies discuss low-code platforms or AI strategy in general terms. Healthcare does not reward generic playbooks. Domain expertise in CMS audit readiness, HEDIS quality measures, and claim adjudication logic cannot be improvised.

Our 25-year engineering partnership with Pegasystems, supported by 2,000+ certified Pega experts and 500+ major enterprise deployments, is built on three practices:

We start with business context, not a blank canvas. Through Virtusa Blueprint Domain Encapsulation paired with Pega GenAI Blueprint, we deploy pre-built case lifecycles, compliance frameworks, and industry data models from day one, rather than building healthcare rules from scratch.
We engineer agentic AI for action, not summarization. Powered by the Virtusa Helio platform, our AI execution engines safely and predictably drive high-volume, multi-step healthcare workflows.
We dismantle legacy systems using an outside-in strategy. Aging mainframes and COBOL systems are decoupled incrementally in the background, keeping daily operations and patient and provider care journeys uninterrupted.

Where deep healthcare context meets enterprise AI

Combining industry consulting depth with Pega's execution engine addresses three operational areas directly:

Member and provider journeys: We reduce friction in onboarding, credentialing, and directory management, giving providers more time for care and members faster access to services. We support this with proactive member engagement, care management, and streamlined claims processing.
Core administrative operations: Using Pega AI and FHIR-based interoperability, we streamline Digital Prior Authorization, Claims Adjudication, Appeals and Grievances, and Provider Lifecycle Management, reducing turnaround times while maintaining audit readiness.
Clinical quality and governance: We build regulatory-ready workflows that automate HEDIS and Stars quality measure tracking and clinical oversight, supporting consistent care delivery across Medicare Advantage, Medicaid, and Commercial lines.

The proof is in the numbers

Claims modernization for a major payer: replacing a decades-old COBOL system with Pega Smart Claims Engine delivered 85% faster processing timelines, an 83 to 85% first-pass auto-adjudication rate, and a 100% reduction in preventable errors.
Sales unification for a health insurer: consolidating fragmented Medicare Advantage, ACA, and Part D channels into a single Pega CRM enabled 40% code reuse, significantly reducing development costs.
Service modernization for a dental benefits provider: replacing an aging Macess system, we moved from initial discovery to a working, AI-ready desktop prototype within a two-week sprint.

Looking Ahead

Dan Kasun, VP of Pega's Partner Ecosystem, noted: "This achievement highlights Virtusa's exceptional expertise in leveraging Pega's powerful capabilities to serve clients in healthcare and life sciences. Together, we are committed to empowering our customers to transform their businesses, using enterprise-grade AI to advance their ability to innovate and grow."

This award reflects the work of our engineering teams, consulting practice, and clients. The priority now is what comes next.

Healthcare requires operational cores built for what is ahead, not incremental fixes to what already exists.

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